AB0426 PROFILE OF REFRACTORY RA PATIENTS FOR TARGETED THERAPIES IN REAL LIFE
Authors: E. Grau García, L. Mas Sanchez, P. Muñoz Martinez, C. Riesco Barcena, A. M. Torrat Noves, E. Tovar-Sugrañes, E. Vicens Bernabeu, H. Charia, L. Gonzalez Puig, A. V. Huaylla Quispe, J. Ivorra Cortés, S. Leal Rodriguez, I. Martínez Cordellat, R. Negueroles Albuixech, J. E. Oller Rodríguez, F. Ortiz-Sanjuán, D. Ramos Castro, I. Cánovas Olmos, C. Nájera Herranz, J. A. Román Ivorra
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> A proportion of RA patients fails to respond to their first targeted therapy (TT), and response decreases with increasing TTs exposures. EULAR have defined refractory RA (refRA) patients as a failure of two or more TTs of differing mechanisms of action. <h3>Objectives</h3> We aimed to determine the clinical and therapeutic profile of refRA and describe the patterns of drug sequencing. <h3>Methods</h3> Cross-sectional, observational study with RA patients diagnosed according to ACR/EULAR 2010 criteria, and exposed to TT over the last 20 years was performed. We classified patients in 1) non-refRA (1 or 2 TTs) and 2) refRA (at least 3 TTs). We analyzed the different lines of treatment with TTs, its duration treatment and reasons for discontinuation of treatment. <h3>Results</h3> 544 RA patients undergoing TTs were included, 122 from them were considered as refRA (at least 3 lines of TTs). RefRA patients showed younger age at diagnosis than non-refRA (P&lt;0.001) but there is no differences on time of disease evolution until de 1st TT in both groups. Anti-TNF was the treatment of choice for the 1stline therapy, however is less likely to be administered in non-refRA rather than refRA (P&lt;0.001) (table 1). "Cycling" after the first-line TTs was frequent in refRA (P&lt;0.001), but from the 3rd-line of treatment "switching" is the main choice and different TTs differing mechanisms of action were used. The absence of conventional DMARD treatment is more likely in refRA, as well as a reduction in the treatment duration as increase the number of treatment lines administered. Secondary non-response in 1st and 2nd TTs were the main reason for discontinuing treatment (P&lt;0.001) in refRA, being the adverse event more frequent as cause of discontinuing treatment in non-refRA (P=0.005). Analyzing the reason for discontinuing treatment and excluding the "other reasons", if the cause of discontinuing treatment in refRA is a primary non-response, near of the 30% of patients discontinue in 2nd-line by the same reason; and if the cause for discontinuation in 1st-line is an adverse effect, the 33% of patients discontinue in 2nd-line by the same reason (see image). <h3>Conclusion</h3> RefRA patients showed lower age at diagnosis. Anti-TNF was the most frequent TT both in 1st and 2nd line of treatment; and as from the 3rd-line there is a switching for TTs with mechanisms of action. Despite to secondary non-response is the most common cause of discontinuation in first and second-line in refRA, we observed a tendency to reiterate in the second-line of treatment the reason for discontinuation of the first-line of treatment. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.